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- Title
"IDENTIFYING THE OPTIMAL MECHANICAL BREATH PROFILE: AN ANIMAL CASE STUDY IN VENTILATION APPROACHES TO THE ARDS LUNG MODEL" A CONSENSUS BY THE INDIVENT WORK GROUP.
- Authors
Restrepo, Ruben D.; Rowley, Daniel D.; Scott, J. Brady; Pasewald, Ron; Lamb, Keith D.; Inkrott, Jon C.; Tanner, Donna; Kriner, Eric J.; Hinkson, Carl R.
- Abstract
Introduction: ARDS continues to be associated with high mortality since early recognition and institution of lung protective ventilation remains a significant challenge in the ICU. Recent literature suggests that mechanical ventilation (MV) should be individualized. Identifying the optimal mechanical breath profile (MBp) could theoretically decrease the incidence of ARDS. Our Individualized Mechanical Ventilation (IndiVent) Work Group convened to discuss current concepts and trends in ARDS mechanical ventilation (MV) management. Methods: Our group consisted of 14 respiratory care professionals from the US and Canada. Over two days, the group discussed concepts related to the optimal MBp and conducted an animal case study in ARDS. Three Yorkshire pigs, instilled with Tween for induction of ARDS, were used as a case study for three approaches to MV management (ARDSnet with High PEEP, ARDSnet with recruitment maneuvers, and Airway Pressure Release Ventilation). Teams discussed how the strategy was used to protect the lung, advantages and disadvantages, and questions related to its use. Perceived barriers to the implementation of lung protective ventilation and the concept of preventing ARDS with a personalized MBp were deliberated. The work group developed consensus statements and responses to key questions for optimizing the MBp, ARDS prevention and MV management. Discussion: Consensus statements coalesced into three broad concepts: 1. Preemptive protective ventilation should be implemented early. Patients at risk for developing ARDS should be prospectively identified and known protective MV strategies instituted earlier. 2) Macro-ventilation is not the same as microventilation. Conventionally monitored parameters are not necessarily reflective of processes taking place at the alveolar level. 3) The MBp for each patient should be individualized. The specific components of a MBp, customized to be protective for each individual patient, may prevent ARDS onset but are not yet fully elucidated. Conclusion: The development of more reflective and clinically feasible monitoring tools is warranted. An early preventive approach to ARDS management deserves much more consideration. Sponsored Research - Dräger Medical funded the travel and housing for all out of town members of the Individualized Mechanical Ventilation (IndiVent) Study Group and covered the cost of animals and supplies for the pilot study. No honorariums were paid and Dräger Medical had no input on the content of the summit lectures or the pilot study, nor did they comment during the group discussions.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF40
- ISSN
0020-1324
- Publication type
Academic Journal